Enhancement with Dry Eye?

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Enhancement with Dry Eye?

Postby 20204me » Sat Jan 26, 2008 5:34 pm

I've been a happy gas perm contact wearer for 30 years, but began to have a dry spot on the right eye. The surgeon removed and said if it came back, he wouldn't do the surgery again and I would need to give up my beloved contacts. It came back.

I had All-Lasik surgery on 11/06/07 (different surgeon, highly recommended, lots of experience) and have had dry eye issues ever since. I have gone from R -7 to -4 and L -7 to -1. My right eye is my dominant eye. I have been fluctuating from L 20/40 to 20/15 and R 20/70 to 20/400.

Initially, I had to take 2 steriods for 2 weeks and lube drops every 2 hours to help with dry eye. This stopped the grittiness and the cornea no longer appears pitted.

I have clear vision (L) for the first 2 hours of the day and then it decreases throughout the day. After drops, I have improvement for a few minutes, then it goes away. Living in Oregon, dark, rainy conditions make this very scary for driving and the doctor (who is the after care doctor, you only see the surgeon for the surgery) won't prescribe glasses because of the changing prescription.

I am taking 2 grams of flaxseed each day. Hot compresses at night. Opticlean lid cleaner nightly. I have tried Muro .5 128 but I got a stye from the mineral oil. (Now on tetracycling to help with styes - I have very mild rosacea and this helps calm things down) I literally purchased every drop on the shelf at Rite Aid and Walmart and seem to do best with Genteal Gel at night and Baush and Lomb rejuvinating dry eye or Celluvisic.

The after care doc put me back on steroids for 2 weeks and placed lower punctal plugs. No improvement. (She doesn't wash her hands between patients!!)

I went back yesterday 10 weeks post-op and said I wished I'd never had this done. The after care doctor said that I would be much happier with the results if I had an enhancement on the right eye. She measured my tear layer (L 3-4, R 1) She said this plays into the fluctuation, but that the left eye is straining to compensate for the right eye and is tired by the end of the day. After sleeping the eye rests and is strong again. She said that drynes is not a factor in the enhancement surgery or recovery. (Seems contradictory if you ask me.)

She wants me to wear a contact in the right eye (remember this is the reason I needed surgery was due to inability to wear contacts) to relax the left eye. She feels enhancement will solve everything. I told her I am not letting them do anything while I am having such fluctuations. She said the vision changes but the prescription doesn't. She finally reluctantly gave me a prescription for Restasis at my request, a glasses prescription (the rx is incorrect for reading as she didn't compensate for the fact the L is +1.5 and the R is +1 - She just made them both +1.5 without an exam.)

I went to my regular optometrist who is now going to begin after care which I will have to pay for (The lasik program provided their aftercare which I feel is incompetent.) My opt said no on the prescription since it is still changing and no way on the enhancement at this point.

Other than thanking you for this tremendous web site that has helped me not lose my mind along with my vision, I wanted to know if you've ever heard of the after care doc's tired eye theory and that dry eye isn't a factor in the enhancement?

I have lost confidence, but not hope.

Thank you.
20204me
 
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Re: Enhancement with Dry Eye?

Postby LasikExpert » Sat Jan 26, 2008 7:42 pm

20204me wrote:She said that drynes is not a factor in the enhancement surgery or recovery.


Absoletuly, completely, and without exception, untrue. A dehydrated cornea will ablate more tissue per pulse of the laser. If not appropriately adjusted, an overcorrection into hyperopia (farsighted, longsighted) vision is all but guaranteed.

20204me wrote:She said the vision changes but the prescription doesn't.


Nonsense. If this was true she would have given you glasses long ago. The reason your vision is fluctuating is because the tear film is fluctuating in both quantity and quality. The tear film is a very important part of the optics of the eye and directly affects refractive error – eye prescription.

20204me wrote:I went to my regular optometrist who is now going to begin after care which I will have to pay for (The lasik program provided their aftercare which I feel is incompetent.)


A very wise decision, but I'll have more about that later.

20204me wrote:Other than thanking you for this tremendous web site that has helped me not lose my mind along with my vision,...


Thanks for the kind words.

20204me wrote:I wanted to know if you've ever heard of the after care doc's tired eye theory and that dry eye isn't a factor in the enhancement?


I believe that is is very likely eye strain is a part of your problem, but eye strain does not exclude the contribution of severe Lasik dry eye.

20204me wrote:I have lost confidence, but not hope.


From what you have described, losing confidence in your Lasik comanagement optometrist was the wisest decision you have made.

I ask that you do something that will be of service to all others in your area who are considering Lasik.

Ask your new optometrist to provide a standard consultation report to your surgeon, with a copy to your previous optometrist who was a part of the Lasik comanagement program. At the same time, write your own letter to the surgeon from your personal perspective, containing everything you have written here.

Wait a week or two for a reply, and then contact the surgeon's office directly and request (demand?) an examination by the surgeon. Let the surgeon's office see for itself the problems poor comanagement have exacerbated.

In light of this situation, it seems absolutely appropriate that you request the surgeon pay for the comanagement care you are receiving from your "out of program" optometrist and at the same time no longer pay for care you are no longer receiving from the first optometrist. Why should she be paid when she is no longer providing care?

If you do not do this, two things are likely to happen. The comanaging optometrist will likely continue to provide what appears to be substandard care, and the surgeon will get a report from the comanaging optometrist that the patient is no longer seeking care for problems and must therefore be considered a success. This would be a disservice to the surgeon and to any other patient who is placed in the same position as you.

Give your surgeon the opportunity to make the changes necessary to stop anyone else from being served so poorly, to provide you with the standard of care that should be expected, and to appropriately serve the Lasik patients of your community.

Give your surgeon the opportunity to be a hero. If s/he does not rise to the ocassion, then you know where you never want to recommend another potential Lasik patient. Even if the surgeon is excellent, a surgeon who tolorates poor pre- and postop care is not an excellent surgeon.
Last edited by LasikExpert on Mon Jan 28, 2008 4:44 pm, edited 1 time in total.
Glenn Hagele
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Postby 20204me » Mon Jan 28, 2008 3:00 am

Dear Glenn,

I cannot thank you enough for your quick reply, knowledge, and sage advice. I will follow the procedures you suggested and hope that the surgeon will not disappoint. The comanagement doctor has made this entire process a nightmare.

I will let you know the results of my efforts. Keep your fingers crossed.

Thank you again.
20204me
 
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Joined: Mon Nov 12, 2007 9:37 pm
Location: Salem, OR


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